This is important in a population where the logistics of treatment are of high value. At this point, you would have to think about different agents. And there is also significant potential, but it is probably more common that the increase will not do the job. We know anecdotally that some people will respond to higher doses of the same medication. There a lot of questions that clinicians have, where we think: If we have a patient on low-dose maintenance, as is the case here with this patient, what is the value of increasing the dose? Or should we switch to another therapy? Part of this is unanswered. For the most part, the patient does well, until a couple of years later when the patient starts to experience relapse. In this case, the patient was started on lenalidomide and low-dose dexamethasone. It is an important factor, because we now know that high-risk myeloma tends to have a slight preference for younger patients.ĭo you continue the patient on lenalidomide or switch to another therapy? In this case, we have a patient who has hyperdiploid disease, which tends to be more common in elderly patients. Part of what we are trying to do is address the importance of looking at the specific details regarding the clinical picture the biology of the disease.
Our first case is a typical situation, where you have an individual who was recently diagnosed with myeloma. TARGETED ONCOLOGY: What are your general impressions of this patient? He reported feeling tired, but continued to do well functionally. Additionally, his M-protein rose from 0.6 g/dL to 1.2 g/dL to 1.5 g/dL. His laboratory findings showed:Hemoglobin levels, 11.4 g/dL creatine clearance, 1.0 mg/dL. After 9 cycles of therapy, the M-spike plateaued at 0.6 g/dL therapy was continued. He received treatment with lenalidomide (Revlimid) at 15 mg daily and low-dose dexamethasone. His cytogenetics showed hyperdiploid disease. Fonseca, professor of medicine, chair, Department of Internal Medicine, Mayo Clinic, explained how he would treat these patients based on case scenarios during a Targeted Oncologylive case-based peer perspectives presentation.Ī 77-year-old African American man received a diagnosis of stage III multiple myeloma 24 months ago and was not eligible for transplant based on his level of frailty. Rafael Fonseca, MD, recently shared the treatment considerations and decisions he makes when treating patients with multiple myeloma.
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